IAPS Penn State – October 23-27, 2002 - State College, Pennsylvania, USA

Conference Registration Form

Last Name ____________________________ First Name ____________ Middle Int ___

Name as you want it to appear on badge_______________________________________

Affiliation_______________________________________________________________

Address ____________________ City _______________ State _____ Zip __________

Country _____________________ Mailing Code ______________________________

Phone _____________ FAX ___________________ E-mail _____________________

Pre-registration for the conference is required with full payment. *Includes general and concurrent sessions, reception, snack/coffee breaks, and conference banquet.

Conference Fees

Registration (until September 13, 2002) Professional $120; Student $80 Amount Due ________ Registration (after September 13, 2002) Professional $150 Student $100

Banquet guest ___ Number of tickets x $ 30.00 Amount Due _________

Total Amount Due _________

Hotel Accommodations

Arrangements have been made at the hotel listed below. Please call to make your own reservations. It is important that you mention that you are attending the IAPS Conference in order to receive the special rate. Days Inn Penn State 240 South Pugh Street State College, PA 16801 Call Toll Free: 1-800-258-3297 Rates: $76 single + 7% hotel occupancy tax $86 double + 7% hotel occupancy tax

Reservation deadline: September 25, 2002. Thereafter, space available basis only.

Special food requirements? Vegetarian: Yes ____ No ____ Other? _______________________

□ Check this box if you require special accommodation. If yes, describe briefly on back of sheet.

Payment Options

Checks or Money Orders: Please make payable to the “IAPS – Scott Kretchmar.” All checks must be in U.S. funds drawn on a U.S. bank. International registrants please use International or U.S. Postal order.

Return completed form and payment to: R. Scott Kretchmar

276-D Recreation Building

University Park, PA 16802 USA